Tackling the diabetes epidemic

The ‘Maastricht Study’, launched in 2010, reveals that the number of people in the preliminary phase of diabetes is much higher than initially thought: roughly a million people in the Netherlands alone. “We’re living in a time in which we can justifiably call diabetes an epidemic”, says Professor Coen Stehouwer, the director of the unique study. The researchers suspect that, beyond lifestyle-related factors, other factors are at play here. The study will run until 2019, but the preliminary results are unequivocal: “We’re living in a time in which we can justifiably call diabetes an epidemic.”

“We’ve now collected data from more than 7,000 of the total of 10,000 participants in the Maastricht-Heuvelland region”, says Professor Coen Stehouwer, the director of the study. “So far this has yielded about 70 terabytes of data, which is a truly remarkable amount. When you consider that just one terabyte – 1,000 gigabytes – would cover every piece of text in a large university library, you can just imagine how much data we’re talking about.”

It is the combination of three qualities, in Stehouwer’s view, that makes the Maastricht Study so unique. “First, including such a large number of participants both with and without type 2 diabetes allows us to study the stages of diabetes and its complications in detail. In addition, we’re mapping practically all of the many possible causes and effects of the disease. And finally, we’re making use of a wide range of sometimes very sophisticated research techniques. When you look at it this way, no other study in the world is comparable with the Maastricht Study.”

Extensive testingThe 10,000 participants – roughly a third of whom have been diagnosed with diabetes – are being followed closely over a period of at least 10 years. “Every participant undergoes extensive testing”, Stehouwer explains. “We have a dedicated research centre in Maastricht-Randwyck where we examine their physical and mental health, their fitness and their lifestyles. And every year we contact the participants again to find out how their health is progressing.”

Striking resultsOne of the tools used in the Maastricht Study is an advanced three-dimensional pedometer. “Participants wear this for eight full days in a row, which allows us to analyse their patterns of movement in detail. What we’re finding is that the average person in South Limburg spends nine hours a day sitting down; actually not much longer than people elsewhere. But all that sitting turns out to be strongly correlated with worse health. And exercising for half an hour a day doesn’t make up for it – sitting is intrinsically bad”, says Stehouwer. “However, what’s striking about our most recent data is that it suggests that if you replace half an hour a day of sitting with walking, climbing stairs or similar activities, you can reduce the risk of diabetes by 20 percent.”

Pre-diabetes“Another important finding is that the number of people in the preliminary phase of diabetes – pre-diabetes, as it’s known – is much higher than initially thought. We’re living in a time in which we can justifiably call diabetes an epidemic. The number of people with diabetes or pre-diabetes is now double what it was 10 or 15 years ago. We’re talking about roughly a million people in the Netherlands alone. So it seems very likely that, beyond lifestyle-related factors, there are other factors at play here. We think that stress, environmental pollution and the inhalation of toxins may play important roles in contributing to the development of diabetes. Still,” Stehouwer continues, “even if you discount all that, it still doesn’t fully explain the drastic increase in the prevalence of diabetes. So there have to be other causes too; causes that are as yet unknown to us.

“Given the epidemic proportions of the disease and the fact that the majority of people with pre-diabetes go on to develop full-blown diabetes, it’s essential that we gain more insight into the contributing processes. If we really want to do something about this epidemic, as a society we should focus on the large group of people with pre-diabetes; for instance, by means of screening. Diabetes has a hugely detrimental effect on quality of life. Around half of patients develop classic symptoms like cardiovascular disease, and around three quarters of those eventually die from it. Not to mention complications that have more recently come to light, such as accelerated cognitive deterioration and depression. Although their effects are not yet clear, they’re likely to have a big impact too.”

Personal lifestyle adviceResearchers involved in the Maastricht Study will continue collecting data in the years to come. The project employs 250 people, including 25 PhD candidates. But science is not the only beneficiary; the study also has value for the participants themselves and for the region. The results are communicated to both participants and their GPs, and participants can request tailored lifestyle advice. Stehouwer: “We hope the data from the Maastricht Study will help to turn the tide of the diabetes epidemic. After all, the knowledge acquired will be put to good use in the development of new methods of prevention, diagnostics and treatment of chronic diseases, in particular diabetes and cardiovascular disease.”

Coen Stehouwer (1960) studied medicine at the Erasmus University Rotterdam. An internist, he is the head of the Department of Internal Medicine at the MUMC+ as well as scientific director of the Maastricht Study. His research focuses on the vascular complications of metabolic diseases, especially diabetes, hypertension and chronic renal diseases.